Injury prevention is crucial with the Women’s Rugby World Cup final due to take centre stage at Twickenham this coming weekend. I’d like to follow on from Part 1 where we analysed the differences in injury types from the Women’s game vs the Men’s game.
Here are my key physio-led strategies tailored to what we know about women’s vs men’s injury risks.
1. ACL & Knee Control (women’s highest burden)
- Warm-up neuromuscular blocks (12 to 15 min): deceleration drills, single-leg hops, change-of-direction under fatigue.
- Strength focus: hamstrings, glutes, quads; include Copenhagen adductor work (1, 2)
- Landing mechanics: plyometric retraining, depth jumps, agility ladders.
2. Hamstring Resilience (men’s most common training injury)
- Manage sprint loads carefully: sudden spikes (or too little exposure) can raise risk. Showed that both underexposure and spikes in sprinting distance >24 km/h were linked to increased HSI risk. (3)
- Test and monitor sprint mechanics and horizontal force capacity to identify risk states. Research found players with low horizontal force (Fₕ₀) in acceleration testing were ~2.7× more likely to suffer HSIs. (4, 6)
- Use progressive high-speed sprinting in combination with eccentric strength training (e.g., NHE) and technical coaching to build resilience against HSIs. (5)
- Pay attention to late swing mechanics and muscle length/tension: injury risk is greatest here due to eccentric strain. HSIs most often occur during late swing phase of sprinting, when hamstrings act eccentrically under stretch. (6,7)
3. Concussion (shared across both codes)
- Education: players, coaches, medics → recognise and remove. (8, 9)
- Rehab (8):
- Vestibular therapy: Adding targeted cervical spine therapy + vestibular rehab to usual care shortened time to medical clearance in athletes with persistent symptoms post-concussion. (10, 12)
- Cervical proprioception: Post-concussion patients demonstrate sensorimotor and mobility deficits supporting targeted cervical assessment/treatment; expert guidance endorses addressing cervical & thoracic dysfunction in rehab. (13),
- Balance training: Post-concussion balance impairment is common; rehab that includes balance components is recommended in expert and review literature (with growing, but still heterogeneous, evidence base). (14)
- Return-to-play protocols: strict adherence; monitor symptom duration. (8, 11)
4. Ankle & Calf Support (England men’s highest-burden site)
- Balance training: Systematic reviews and meta-analyses show that neuromuscular and balance training (e.g. wobble boards, single-leg stance with perturbations) reduces the incidence of recurrent ankle sprains in athletes. (15, 16)
- Calf raises & hopping: Eccentric and concentric calf strengthening (heel raises) improve ankle function and reduce injury recurrence. (17) Plyometric/hopping drills restore lower-limb stiffness and elastic energy return, key for sport performance and ankle injury resilience. (18)
- Tape/brace protocols: There are no recent studies that look specifically at using strapping or bracing during return to sport. Bracing and taping have been shown to improve function in rehab and may have benefits in RTP especially in the early stages.
5. Shoulder & Tackle Conditioning
- Scapular & rotator cuff strength: banded ER, prone YTWs, push-up plus has strong support in systematic reviews and guidelines. These exercises address strength, scapular control, and neuromuscular function → key determinants of shoulder stability and contact readiness. (19, 20, 21)
- Contact prep: graded exposure—controlled → semi → full → live. (22, 23)
6. Training Load Management
- Women: focus on reducing game-based full-contact drills (WRISP’s top training burden).
- Men: monitor running volumes and sprint exposure.
- Both: avoid stacking contact + high-speed + COD in one session.
Final Thoughts
The Women’s Rugby World Cup 2025 at Twickenham is not just a showcase of elite rugby, it’s a chance to reflect on what the data tells us.
- Overall incidence rates are similar between women and men.
- Women’s injuries last longer, with knees taking the heaviest toll.
- Men’s burden falls on hamstrings and ankles, but tackles and concussions unite both codes.
As physiotherapists, we can make a tangible impact through evidence-based prevention, tailored rehab, and smarter load management, ensuring both women and men step on the pitch fitter, safer, and ready to perform.
If you’re a player or coach in London preparing for the season ahead and want a screening, prevention programme, or post-injury rehab, book an appointment with us today.
References:
1 – Ishøi L, Sørensen CN, Kaae NM, Jørgensen LB, Hölmich P, Serner A. Large eccentric strength increase using the Copenhagen Adduction exercise in football: A randomized controlled trial. Scand J Med Sci Sports. 2016;26(11):1334–1342. https://pubmed.ncbi.nlm.nih.gov/26589483/
2 – Harøy J, Clarsen B, Wiger EG, Øyen MG, Serner A, Thorborg K, Hölmich P, Andersen TE, Bahr R. The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 2019;53(3):150–157. https://pubmed.ncbi.nlm.nih.gov/29891614/
3 – Duhig S, Shield AJ, Opar D, Williams M, Timmins R, Hickey J. Effect of high-speed running on hamstring strain injury risk. Br J Sports Med. 2016. https://pubmed.ncbi.nlm.nih.gov/27288515/
4 – Lahti J, Nagahara R, Edouard P, et al. Low horizontal force production capacity at low velocity is a potential risk factor for hamstring injuries in football. Int J Environ Res Public Health. 2021. https://pubmed.ncbi.nlm.nih.gov/34360125/
5 – Tedeschi F, Medeiros A, Baroni BM. Sprint Training for Hamstring Injury Prevention in Soccer Players: A Scoping Review. Appl Sci. 2025. https://www.researchgate.net/publication/394897390_Sprint_Training_for_Hamstring_Injury_Prevention_A_Scoping_Review
6 – Bramah C, Rhodes S, Clarke-Cornwall A, DosSantos T. Sprint running mechanics associated with hamstring strain injury: a 6-month prospective cohort study of 126 elite male footballers. Br J Sports Med. 2024. https://bjsm.bmj.com/content/early/2025/05/24/bjsports-2024-108600
7 – Danielsson A, Horvath A, Senorski, C, et al. The Mechanisms of hamstring injuries: a systematic review. BMC Musculoskelet Disord. 2020;21:641. https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-020-03658-8
8 – Patricios J, Schneider K, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport – Amsterdam, October 2022. Br J Sports Med. 2023; 53:695. https://bjsm.bmj.com/content/bjsports/57/11/695.full.pdf
9 – If In Doubt, Sit them Out. UK Concussion Guidelines for Non-Elite (Grassroots) Sport. https://sportandrecreation.org.uk/files/uk-concussion-guidelines-for-grassroots-non-elite-sport—november-2024-update-061124084139.pdf
10 – Schneider K, Meeuwisse W, Nettel-Aguirre A, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. Br J Sports Med. 2014; 48(17):1294.https://pubmed.ncbi.nlm.nih.gov/24855132
11 – NICE Head Injury: Assessment and early management. https://www.nice.org.uk/guidance/ng232/resources/head-injury-assessment-and-early-management-pdf-66143892774085
12 – Galeno E, Pullano E, Mourad F, et al. Effectiveness of Vestibular Rehabilitation after Concussion: A Systematic Review of Randomised Controlled Trial. Healthcare (Basel). 2022 11(1):90 https://www.mdpi.com/2227-9032/11/1/90
13 – Kinney A, Richmond S, Mizner R. Cervical spine sensorimotor deficits persist in people post-concussion despite minimal symptoms. Ann. Med. 2024 7;56 (1):2422048. https://www.tandfonline.com/doi/full/10.1080/07853890.2024.2422048#abstract
14 – Art K, Ridenour C, Durbin S, et al. The Effectiveness of Physical Therapy Interventions for Athletes Post-Concussion: A Systematic Review. Int J Sports Phys Ther. 2023 1;18(1):26-38. https://ijspt.scholasticahq.com/article/68071-the-effectiveness-of-physical-therapy-interventions-for-athletes-post-concussion-a-systematic-review
15 – Schiftan G, Ross L, Hahne A. The effectiveness of proprioception training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis. J Science and Med in Sport. 2015 18(3):238-244. https://doi.org/10.1016/j.jsams.2014.04.005
16 – Delahunt E, Bleakley C, Bossard D. et al. Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium. Br J Sports Med. 2018; (52):1294. https://bjsm.bmj.com/content/52/20/1304.full
17 – van der Wees PJ, Lenssen AF, Hendriks EJM, Stomp DJ, Dekker J, de Bie RA.
Effectiveness of exercise therapy and manual mobilisation in ankle sprain and functional instability: a systematic review. Australian J Physio 2006;52(1):27-37. https://www.sciencedirect.com/science/article/pii/S0004951406700599
18 – Markovic G, Mikulic P. Neuromuscular adaptations to training and testing of leg stiffness in jumping and hopping: a review. Eur J Appl Physiol. 2010;109(5):823–849. https://doi.org/10.2165/11318370-000000000-00000
19 – Melo A, Moreira J, Afreixo V. et al. Effectiveness of specific scapular therapeutic exercises in patients with shoulder pain: a systematic review with meta-analysis. JSES Rev Rep Tech 2024; 19;4(2):161-174 https://pmc.ncbi.nlm.nih.gov/articles/PMC11065746/
20 – Lafrance S, Charron M, Dube M. et al. The Efficacy of Exercise Therapy for Rotator Cuff-Related Shoulder Pain According to the FITT Principle: A Systematic Review With Meta-analyses. JOSPT 2024; 54(8):499-512. https://www.jospt.org/doi/10.2519/jospt.2024.12453
21 – Wu D, Wen Z, Ke H, et al. Specific modes of exercise to improve rotator cuff-related shoulder pain: systematic review and meta-analysis. Front Bioeng Biotechnol 2025; 8(13):1560597 https://pmc.ncbi.nlm.nih.gov/articles/PMC12011739/
22 – Tucker R, Ryan D, Gray R, Harrington M World Rugby: Competition Ready Guidelines. 2021. https://resources.world.rugby/worldrugby/document/2021/05/05/9afc79bf-f9c2-472e-8c5b-a40f838c793b/210422-RTP-guidelines.pdf
23 – World Rugby – Tackle Ready – a guide to safe and effective tackling. https://passport.world.rugby/injury-prevention-and-risk-management/tackle-ready/
